There is a strange new conversation to be had among addiction treatment professionals, lawmakers, prevention advocates and anyone else with a stake in the opioid epidemic currently consuming the United States. The Centers for Disease Control and Prevention (CDC) recently issued a report indicating that the number of opioid prescriptions written by physicians peaked in 2010 and then decreased each year in 2015. While they’re still three times as high as they were in 1999, the continued decrease would suggest a positive shift in what many feel is a culture of over-prescribing that is one of the key contributors of opioid addiction and overdose.

Loved ones of the over 33,000 American who died from opioid overdose in 2015 may find this news hard to believe. Since 2014, the nation has seen record-breaking opioid fatality rates and 2016 figures, while preliminary, are expected to approach 60,000 deaths. The CDC reports that prescription opioid-related overdose deaths and admissions for treatment of opioid use disorder have increased in parallel with increases in opioids prescribed in the United States, which quadrupled from 1999 to 2010. There was notable geographical variation among those who were prescribed prescription opioids, with counties with the highest rates beating the counties with the lowest by about 600 percent.

The lack of consistency between the decline of physician-sanctioned prescriptions and the sharp rise in deaths may, in some part, be attributable to illicit opioids like heroin. It can also have something to do with the street-level sale of fentanyl. The trend seems to suggest that overdose rates affect illicit users over those who have developed abuse from a legitimate supply of prescription painkillers. In Florida, the home of RU’s flagship facility and a former hotbed of excessive opioid prescribing, the amount of opioids prescribed per capita decreased in 80% of counties from 2010 to 2015. This is due, in large part, to federal crackdowns and other types of law enforcement intervention.